Evaluating the Effect of High Dose Versus Low Dose Heparin in Peripherally Inserted Central Catheter in Very Low Birth Weight Infants

Background: Although heparin may be effective in reducing risk of catheter blockage, there are several concerns about the use of heparin in patients with peripherally inserted central catheter (PICC), including decreasing platelet count and intra ventricular hemorrhage (IVH). There is limited evidence of an association between this risk and dose of heparin. According to the limited studies that have compared high dose and low dose of heparin on PICC patency and complications, this study aimed at comparing the effect of low dose and high dose heparin on central catheter patency in very low birth neonates in Isfahan, the third populated province of Iran. Objectives: The aim of this study was to evaluate the optimal dose of heparin in peripherally inserted central catheter in very low birth weight infants. Methods: This randomized clinical trial was conducted on 106 very low birth weight neonates with PICC. The neonates were divided to 2 groups, including low dose and high dose groups. The low dose group received 1.5 unit/kg/hour of heparin and the high dose group 0.5 unit heparin/1 cc of serum. The primary outcomes were the duration of time that the catheter was open and lack of occlusion. Catheter occlusion was defined as inability to push 1 cc of normal saline 0.9% with a 5 cc syringe. The secondary outcome was incidence of sepsis, catheter related sepsis, phlebitis, thrombocytopenia, skin reaction, IVH, and grade of IVH and death rate. Results: In this study, 106 neonates with mean age of 28.83 weeks participated, 43.4% of which were male. The mean duration of time that the catheter was open was similar in both low dose and high dose groups. The incidence of complications, including sepsis, thrombosis, bleeding, IVH and increasing blood pressure, were not significantly different between the 2 groups. Conclusions: This study suggested that using low dose of heparin is as effective as high dose heparin in reducing catheter occlusion and improving catheter patency and it is better to administer low dose heparin in neonates, who had central catheter to maintain its patency.